LARS BERGESON MD PC NPI 1336335884

NPI Information

LARS BERGESON, MD, PC is a health service clinic center in Providence, UT. LARS BERGESON, MD, PC NPI is 1336335884. The provider is registered as an organization entity type.

The provider's business location address is:

382 N 280 W
PROVIDENCE, UT
ZIP 84332-609
Phone: (435) 752-0330
Fax: (435) 755-0922

The provider's authorized official is Lars Bergeson .
The authorized official title is Owner and has the following contact phone number (435) 752-0330.

The enumeration date for this NPI number is 9/19/2007 and was last updated on 2/1/2010.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

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